The Intersection of HIV, Social Vulnerability, and Reproductive Health: Analysis of Women Living with HIV in Rio de Janeiro, Brazil from 1996 to 2016

Abstract

Comprehensive care for sexual and reproductive health (SRH) and social needs for women living with HIV remains limited globally. We aimed to assess trends in baseline sociodemographic, clinical, sexual, and reproductive characteristics among a cohort of HIV-infected women in Rio de Janeiro from 1996 to 2016. Participants were stratified into four time periods based on year of enrollment; we compared cross-sectional data from each period. Of 1361 participants (median age 36), most were black or mixed race (60.1%), unemployed (52.1%), and without secondary education (54%). Adolescent pregnancy was common (51.5%), and 18.3% reported sexual debut at < 15 years old. Nearly half (45.2%) had < 5 lifetime sexual partners, yet prior syphilis and oncogenic human papillomavirus prevalence were 10.9% and 43.1%, respectively. Lifetime prevalence of induced abortion was 30.3%, and 16% used no contraceptive method. Future research should explore interactions between social vulnerability, HIV, and poor SRH outcomes and healthcare models to alleviate these disparities.

“As a Young Pregnant Girl… The Challenges You Face”: Exploring the Intersection Between Mental Health and Sexual and Reproductive Health Amongst Adolescent Girls and Young Women in South Africa

“…Poor mental health, including depressive disorders and stress, contributes significantly to the burden of disease in South Africa, and other parts of sub-Saharan Africa, and is also associated with negative sexual and reproductive health (SRH) outcomes for women, such as ‘unintended’ or early pregnancy, and increased risk behaviours for HIV [ 1 – 3 ]. Researchers in the field of women’s health have highlighted the need to further explore the syndemic interactions between psychosocial vulnerability, mental health, HIV infection, and poor SRH outcomes [ 4 ]. In South Africa’s HIV epidemic, the largest in the world, a quarter of all new infections occur amongst adolescent girls and young women (AGYW) aged 15–24, three times as high as their male counterparts [ 5 ].…”

Prevalência e fatores associados ao aborto induzido no ingresso em uma coorte de mulheres vivendo com HIV/aids, Rio de Janeiro, Brasil, 1996-2016

“…Cad. Saúde Pública 2020; 36 Sup 1:e00201318 Of all the women (with and without previous pregnancy), 30.4% reported an induced abortion any time in life (Table 2), and 39.9% reported more than one induced abortion. In the period from 2006 to 2016, 96% of the induced abortions occurred before the woman was diagnosed with HIV.…”

“…Other improvements in care for persons living with HIV/AIDS in Brazil include encouragement of early diagnosis and expansion of access to highly active antiretroviral therapy (HAART). A study at our service found an increase from 1996 to 2016 in the proportion of women with undetectable viral load, high CD4 count, and use of HAART at entry in the cohort 30 , demonstrating that these women have also benefited from these advances. The declining mortality and increasing survival of persons living with HIV/AIDS 31 , the reduction in MTCT of HIV infection, and the expansion of more effective contraceptive methods in our cohort, based not only on exclusive condom use, may have resulted in less use of abortion as a way of regulating fertility, affecting the reproductive choices of these WLHA.…”

Visões e práticas de mulheres vivendo com HIV/aids sobre reprodução, sexualidade e direitos

“…Assim, obstáculos potenciais à adoção de métodos contraceptivos devem ser alvo do cuidado em saúde para promover autonomia reprodutiva às MVHA. A integração do planejamento familiar aos cuidados com o HIV fornece um modelo para aumentar a acessibilidade e potencialmente melhorar os resultados da saúde reprodutiva 24 .…”